This week of grand rounds began with an evidence based algorithm for COPD management in the ED with Drs. Lane and Hall. Dr. Faryar then led us through a discussion on various common hand injuries. Dr. Fermann guided us through the management of a feared patient presentation: patients with atrial fibrillation and heart failure. The day continued with Dr. Banning’s Taming the SRU lecture about a case she had of a seizing pregnant patient. Dr. Frederick then gave us an overview of toxic alcohols. The day ended with a pediatric trauma simulation and several pediatric oral boards cases.

In this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department. Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria? Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?

Spinal epidural abscess - what was once a 'white whale’ diagnosis in the Emergency Department, has, with the opiate epidemic and rise in IV drug use, become a consistent specter in our differential diagnoses. Potentially debilitating, potentially deadly, devilishly difficult to diagnose in it’s early stages; spinal epidural abscesses have become a persistent concern for patients presenting to the ED with back pain. Much like syphillis, lupus, and HIV, the response to the question of “could it be a spinal epidural abscess?” is usually “ughh, yeah I guess so.” In this article, we will briefly cover the pathogenesis and presentation of spinal epidural abscessed and delve more deeply into the question of how best to treat these patients? What are the triggers for surgical intervention? Are patient’s with neurologic deficits doomed to a life of persistent neurologic disability?

This weeks grand rounds started off with a discussion on the utility of the bougie in airway management by Dr. Carleton. This was followed by Dr. Kiser and Dr. Gensic who led us through a case-based discussion on complex laceration repairs encountered in the community ED setting. Dr. Neth then presented the evidence behind the use of epinephrine and mechanical CPR in out of hospital cardiac arrest. Next up was Dr. Soria who presented a case of Wernicke’s Encephalopathy with some learning pearls about this often under-diagnosed condition. Dr. Goel then masterfully answered the CPC challenge placed by Dr. Li to diagnose a rare case of ocular syphilis. Dr. Berger then finished the day with an overview of necrotizing fasciitis and the LRINEC score.

The first of a new series of posts with associated podcasts looking at the literature behind what we do every day in the ED with takeaways of tangible algorithms to guide every day practice. This month Drs Gauger and Harty lead us in a discussion of cardiac arrest, the drugs we use, the ultrasound we dabble with and the future interventions that could become standard of care.

When a patient with a history of recent IVDU presents with a complaint of fever, the mind of the provider should immediately focus on the numerous possible infectious complications that can arise. Infectious endocarditis can lead to septic emboli spread to any organ system. Pneumonia can result from aspiration or septic embolization. Cellulitis/abscess can obviously result from local injection. But what about when a source of fever is not readily identifiable? When cultures are negative and the patient’s symptoms have resolved, what could have been the cause of their febrile illness?

This weeks grand rounds started off with a Morbidity and Mortality presentation by Dr. Baez including topics such as STEMI in LVH, pharmocologic cardioversion, and septic arthritis of the finger. This was followed by Dr. Freiermuth who gave us some pearls on the approach and management of sickle cell patients in the ED. Dr. Shaw then discussed some disturbing new health policy issues. Dr. Essell, a Heme/Onc attending at Jewish Hospital then walked us though GvHD, Acute Leukemia emergencies, and a fascinating new treatment option for blood cancers CAR-T. The day continued with a review of burn management by Dr. Spigner. Dr. Walsh then finished the day with an overview of carboxyhemoglobinemia and methemoglobinemia.

The week started off with our AirCare team discussing indications for procedures performed pre-hospital. The AirCare team continued by taking us through several cases in our quarterly AirCare M&M. We then got some oral boards practice with Drs. McDonough and LaFollette. The day finished with a simulation led by Dr. Hill covering patients who wish to leave AMA as well as the terrifying lengthening QTc.

The week started off with a discussion on research and ways to get involved during residency. We then got a primer on early pregnancy ultrasound and ectopic pregnancy from Dr. Stolz. Our yearly directives series covered personal finance/loans as well as the job search and contract negotiation. Dr. Stettler then gave us some pearls on how to manage the agitated patient. This was followed by Dr. Plash who discussed the removal of GI foreign bodies. We then ended with a visiting lecturer, Michigan Program Director Dr. Laura Hopson, who covered bedside teaching tips and tricks.

This week started with a discussion on how we can improve our documentation to maximize our level V billing. This was followed by a summary of practice changing literature over the last year, a discussion on how we deal with failure in the clinical setting, and a guide to the approach of the agitated pediatric patient. Finally, we broke into small groups to learn about ENT emergencies.

Chock full of didactic pearls, this week EM/Sports Medicine physician Dr. Betz started us off with a number of can’t-miss orthopedic injuries. Drs. Baez and Owens led us through case follow ups of air embolism and a sick neonate in shock. To finish up, Wilderness Medicine’s own Drs Mel Otten and Conal Roche taught us about marine and snake envenomations and dive injuries.

This week started with our monthly Morbidity and Mortality conference where we discussed posterior MIs, tough dissections and more tough cases. We then heard a debate on the use of D-Dimer in the diagnosis of aortic dissection. Finally, we were led through a simulation of a sick GI bleed requiring Minnesota tube placement, and we discussed optimal management of these challenging patients.

This week’s Grand Rounds started with a leadership session led by Dr. Stettler where we discussed the qualities of strong leaders and how we can use those qualities to implement change within our department and health system. Dr. Knight covered the management of concussions and spinal cord injuries in the emergency department. From there, Dr. LaFollette led us through a discussion of how to manage various ENT and ophthalmology complaints in the community setting.

Let the new year begin! This year’s Grand Rounds kicked off with a series of topics covering why what we do matters, and that starts with how we as ED providers conduct ourselves. Dr. Palmer started us off with a discussion of teamwork, how to overcome difficult teamwork scenarios and overcome adverse encounters with integrity. Dr. Doerning gave some insights and lessons in analytics and a foray into datasets using ‘R’ and Dr. McDonough led the group in a talk and small group exercise in professionalism.

Taming the SRU

SRU (pronounced "shrew") = Shock Resuscitation Unit

Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.

SRU (pronounced "shrew") = Shock Resuscitation Unit

Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.